Thirty-three-year-old Ameera Shah is the managing director and chief executive of Metropolis Healthcare Ltd., a Mumbai-based chain of 100 pathology laboratories with a presence in five countries; India, Sri Lanka, United Arab Emirates and South Africa.

Born in Mumbai, Ms. Shah went to the U.S. for university and after graduating worked for Goldman Sachs Group Inc. (GS), an investment bank in New York, and then for couple of U.S.-based startups.

But her dream of working in India pulled her back to the country in early 2000.

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On her return she took over her father’s single lab venture, Dr. Sushil Shah’s Laboratory in Mumbai, changed its name to Metropolis Healthcare and expanded the business mostly by partnering with local laboratories within and outside India.

Ms. Shah got her first funding for expansion in 2006 from ICICI Bank Ltd.’s venture fund. In 2010, New York-based private equity firm Warburg Pincus L.L.C., bought out ICICI’s venture stake, injected $85 million to grow the company to what it is today.

In the latest in our Women at Work series, Ms. Shah talked to The Wall Street Journal about being mistaken for a secretary in the boardroom, dealing with preconceptions about women in the workplace and why India lacks a support structure for female entrepreneurs.

Edited Excerpts:

The Wall Street Journal: How do you think your industry differs for men and women?

Ameera Shah: Quite a lot. I think in India men usually believe there is a certain role for women: In the home as a mother taking care of children. If [women are] working men tend to think they should not be in a decision making role.

I think for me the challenge has always been on two fronts: Gender and age. On the gender front, the challenge has always been people questioning my decision to work. My partners would ask, ‘Are you going to work part-time or full-time? When you get married, if you have kids will you continue working?’

In my mind these questions are not even debatable because I have built a business. If I get married and have children I’m not going to stop working. Where’s my business going to go? It’s not like I am going to sell off.

With customers I have had situations that many women have had.

If I walk into a room with a male junior colleague, the customer will assume he’s the managing director and I am the secretary. This happens regularly. They later realize that I am the managing director and that the man is the sales’ manager.

You have to roll with it. When you are younger it affects you and you think it’s unfair. Then you accept that this is reality and find your own way to handle things.

WSJ: What are the particular strengths you think women can bring to your line of work that perhaps men lack?

Ms. Shah: I can be absolutely sure that being a woman has helped me. The business model we have at Metropolis, I don’t think it could be run by a man because it’s about being softer, it’s not about being aggressive.

I think it would be very hard for a man to be able to take that step back and take that softer route. Women’s way of managing tends to be softer, or consensus building, more diplomatic. For a man it is usually very confrontational.

Maybe our business model is like this because of my gender.

WSJ: How do your employees see you as a boss?

Ms. Shah: I think there is a comfort for lot of them to work for a woman. Almost 55% of my workforce is female. Understanding the mindset of employees, understanding the challenges they face, providing that flexibility, I think comes probably easier for a woman leader than probably for a male leader.

WSJ: Does that mean you give special privileges to your female employees compared to their male peers.

Ms. Shah: I believe it’s an equal workplace, everybody has to prove themselves, there are no exceptions made for women.

But you can provide flexibility in the way of understanding.

I am a big proponent for balance between life and work. I don’t run an organization where I tell people you have to be working 14 hours-a-day, that’s not the kind of business I want to build. It’s unsustainable, people burn out, they don’t give their best.

I believe in a good work-life balance, and I think having a large amount of woman in the workforce, as well as my mindset, creates a good culture.

WSJ: How do your male employees react to having a woman boss?

Ms. Shah: The four men who report to me are all in their late 40s or late 50s and I think for them the challenge is both my gender and age.

They haven’t worked for a younger female boss before, their apprehension lasts about a month to three months.

I use a consensus building approach where key guys are involved in every decision. Once they are given empowerment, once we understand each other, have each other’s respect…then it becomes two people across the table.

Once you are there, these things like age and gender don’t matter.

WSJ: What have been the challenges to your success and how have you dealt with them?

Ms. Shah: People see me first as a woman and then as a business leader and that becomes an obstacle to them building a relationship.

But I have stopped seeing things as a challenge. I have accepted the reality and I work around it.

I tell this to women business leaders who are growing in their businesses: ‘Put aside these thoughts so that they don’t become excuses or justifications for not succeeding. Put them aside and say, this is how it is and how can I find my way to still get what I want?’

WSJ: Are these challenges as a woman business leader specific to the Indian context, or do you think it’s the same world-over?

Ms. Shah: I think there are elsewhere as well but I don’t think they are as intense in other countries.

Sheryl Sandberg spoke about it in a book [“Lean In”]and other leaders talk about the glass ceiling being there around the world.

The perceptions are different though. In India the perceptions are very much that you are a woman, your role is to be a good wife, a good mother.

What all countries have in common is the challenge of relationship building for women. Men in their old boys’ networks build relationships over alcohol, cigarettes, woman and all kinds of other activities such as golf and trips. For a woman to build relationship with her male customers, she has to find new avenues and be more innovative.

WSJ: What do you think needs to change for India to have more women become entrepreneurs and business leaders?

Ms. Shah: Today, the unfortunate part is we talk about women leaders in India but we see very few entrepreneurs. We see a lot of professionals, we see a lot of the banks run by women leaders. But we don’t see many entrepreneurs.

As a female professional leader you operate in a structure that has already got the culture of expertise and knowledge. You still have a lot of those challenges, but as an entrepreneur when you are building something from scratch, you face a lot of issues, and you don’t have that structure around you. Entrepreneurs need to rely on friends, relatives, business associates and advisors.

What is lacking for women entrepreneurs is that support system of people they can call up, because their friends tend to be other women who don’t face these issues. They don’t have male friends, because men don’t become friends with women.

That’s the challenge today for women entrepreneurs. In some way these women entrepreneurs can become this support system for other women entrepreneurs. Or men could change their mindset and say ‘I’m going to see a business leader as an entrepreneur first and a woman second.’

I think we will see many woman entrepreneurs then, because the capability is there, the will is there, it’s just the support system that’s lacking.

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India Real Time offers analysis and insights into the broad range of developments in business, markets, the economy, politics, culture, sports, and entertainment that take place every single day in the world’s largest democracy. Regular posts from Wall Street Journal and Dow Jones Newswires reporters around the country provide a unique take on the main stories in the news, shed light on what else mattered and why, and give global readers a snapshot of what Indians have been talking about all week. You can contact the editors at indiarealtime(at)wsj(dot)com.